Vasoplegia after implantation of a continuous flow left ventricular assist device: incidence,outcomes and predictors

Background

Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients.

Methods

Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n?=?118, 2006–2013) and a temporal validation cohort (n?=?73, 2014–2016). Vasoplegia was defined taking into consideration low mean arterial pressure and/or low systemic vascular resistance, preserved cardiac index and high vasopressor support. Vasoplegia was considered after bypass and the first 48?h of ICU stay lasting at least three consecutive hours. This concept of vasoplegia was compared to older definitions reported in the literature in terms of the incidence of postoperative vasoplegia and its association with adverse outcomes. Logistic regression was used to identify independent predictors. Their ability to discriminate patients with vasoplegia was quantified by the area under the receiver operating characteristic curve (AUC).

Results

The incidence of vasoplegia was 33.1% using the unified definition of vasoplegia. Vasoplegia was associated with increased ICU length-of-stay (10.5 [6.9–20.8] vs 6.1 [4.6–10.4] p?=?0.002), increased ICU-mortality (OR 5.8, 95% CI 1.9–18.2) and one-year-mortality (OR 3.9, 95% CI 1.5–10.2), and a higher incidence of renal failure (OR 4.3, 95% CI 1.8–10.4). Multivariable analysis identified previous cardiothoracic surgery, preoperative dopamine administration, preoperative bilirubin levels and preoperative creatinine clearance as independent preoperative predictors of vasoplegia. The resultant prediction model exhibited a good discriminative ability (AUC 0.80, 95% CI 0.71–0.89, p?<? 0.01). Temporal validation resulted in an AUC of 0.74 (95% CI 0.61–0.87, p?<? 0.01).

Conclusions

In the era of the new generation of cfLVADs, vasoplegia remains a prevalent (33%) and critical condition with worse short-term outcomes and survival. We identified previous cardiothoracic surgery, preoperative treatment with dopamine, preoperative bilirubin levels and preoperative creatinine clearance as independent predictors.

     

Identification of a Novel, Putative Rho-specific GDP/GTP Exchange Factor and a RhoA-binding Protein: Control of Neuronal Morphology

The small GTP-binding protein Rho has been implicated in the control of neuronal morphology. In N1E-115 neuronal cells, the Rho-inactivating C3 toxin stimulates neurite outgrowth and prevents actomyosin-based neurite retraction and cell rounding induced by lysophosphatidic acid (LPA), sphingosine-1-phosphate, or thrombin acting on their cognate G protein–coupled receptors. We have identified a novel putative GDP/GTP exchange factor, RhoGEF (190 kD), that interacts with both wild-type and activated RhoA, but not with Rac or Cdc42. RhoGEF, like activated RhoA, mimics receptor stimulation in inducing cell rounding and in preventing neurite outgrowth. Furthermore, we have identified a 116-kD protein, p116^Rip, that interacts with both the GDP- and GTP-bound forms of RhoA in N1E-115 cells. Overexpression of p116^Rip stimulates cell flattening and neurite outgrowth in a similar way to dominant-negative RhoA and C3 toxin. Cells overexpressing p116^Rip fail to change their shape in response to LPA, as is observed after Rho inactivation. Our results indicate that (a) RhoGEF may link G protein–coupled receptors to RhoA activation and ensuing neurite retraction and cell rounding; and (b) p116^Rip inhibits RhoA-stimulated contractility and promotes neurite outgrowth.     

New species, observations, and a list of new records of brown algae (Phaeophyceae) from the Hawaiian Islands

Two new species of brown algae (Phaeophyceae), Padina moffittiana Abbott et Huisman, sp. nov. and Cutleria irregularis Abbott et Huisman, sp. nov., are described from the Hawaiian Islands (between 19°04′N, 155°35′W and 28°25′N, 178°20′W). In addition, the new combination Cutleria canariensis is proposed for Aglaozonia canariensis. New observations are presented on Nereia intricata Yamada, a species described 67 years ago and known only from its type specimen. New records of a further 14 species are given for the Hawaiian Islands. These 17 taxa bring the total number of species of brown algae recorded for the Hawaiian Islands to 55, an increase of 28%. Of the 15 new records, two are recent ‘accidental’ introductions: Dictyota flabellata (Collins) Setchell et Gardner and Sargassum muticum (Yendo) Fensholt from California. Six records are notable because of their great distances from previously known collections: Nereia intricata Yamada from the Ryukyu Is., Japan; Discosporangium mesarthrocarpum (Meneghini) Hauck, from the Adriatic, Mediterranean, warm Atlantic and southern Australia; Distromium flabellatum Womersley, Spatoglossum macrodontum J. Agardh, and Sporochnus moorei Harvey, from Australia; Desmarestia ligulata (Lightfoot) Lamouroux from temperate and colder waters in the Pacific and Atlantic. A comparison with some Japanese species of Padina confirms that Padina japonica Yamada should be subsumed with Padina sanctae‐crucis Børgesen, as proposed earlier.     

Production of hemoglobin C in the Moufflon (Ovis musimon pallas, 1811) and the Barbary sheep (Ammotragus lervia pallas, 1777) during experimental anemia: Amino acid composition of tryptic peptides from the βB and βC chains

A hemoglobin ^C chain has been detected in anemic Moufflon and in anemic Barbary sheep. Results of limited structural studies suggest that these ^C chains are closely related to the ^C chains which are produced in the domestic sheep and goat during experimental anemia and rather different from the ^C chain of certain nonanemic Barbary sheep. The structural variability among the chains of some nonanemic Caprini species is greater than that observed for the ^C chains of the same animals.This research was supported in part by United States Public Health Service Research grant HE-05168.     

Metabolism of polycyclic aromatic hydrocarbons in cultured human leukocytes under genetic control

Summary Metabolism of the polycyclic hydrocarbon benzo(a)pyrene(BP) to watersoluble products was measured in cultured human leukocytes from 35 healthy volunteers. The classification into 3 different groups with respect to degree of BP metabolism fits that obtained in a previous population and family study, where only the ratio of aryl hydrocarbon hydroxylase (AHH) activity of 3-methylcholanthrene (3MC) treated cultures to the activity of control cultures was measured. These data support previous observations that metabolism of polycyclic hydrocarbons is under genetic control.

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Zusammenfassung In der vorliegenden Arbeit wurde der Metabolismus des carcinogenen Kohlen wasserstoffes Benzpyren zu wasserlöslichen Produkten in Leukocytenkulturen von 35 gesunden Individuen untersucht. Hinsichtlich der Geschwindigkeit im Benzpyrenmetabolismus können 3 Gruppen unterschieden werden. Diese Einteilung ist in völliger Übereinstimmung mit der einer Populations-und Familienstudie, wo das Verhältnis der Aryl-Hydrocarbon-Hydroxylase-Aktivität von 3-Methylcholanthren-behandelten Leukocytenkulturen zu der von Kontrollkulturen bestimmt wurde. Diese Ergebnisse stützen die Beobachtung, daß der Metabolismus von carcinogenen Kohlenwasserstoffen unter genetischer Kontrolle ist.

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This work was supported in part by NIH Research Grant GM 15597 and Grant Ke 217/1 Deutsche Forschungsgemeinschaft (DFG).